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Spokane County ,mla
DEPARTMENT OF 11UILDI'NO &£AEE.TY� ° SSC
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A Division of public Wofl s uIseH
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INFORMATION WORKSHEET
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CITY/STATS/SIP! 501.-- . u.) - °M2-4(/
f unbxtISION: ?C. p U 1J Sk-C-i S �i IZS� 19-01 1`�l o
?LOCH: I LOT: 5 EONEt(JS XE) DISTRICT:
Lot AREA: Pe/At WIDTH: 9 (3 DEPTH: )*0 R/W: )(1)
# or ?UILbINGS: ) 1 or DWELLINdS: WATER DISTRICT:
o*NEA:..N.o-A ge (L�S)r% PHoNE: 5,O4 _ 9tk O(SZ
NAILING AbbREss: �( \
CITY/STATE/ZIP:
CONTACT: ¶ CAx� QOLAW-LbS PHONE: 504 -9%1 - C4SS
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BUILDINd INFORMATION
CONTRACTOR LICtHsn NUMBER: SFOt&gS t (2(oo(Q 3K-\/-no(c&
CONTRACTOR
:
NAILINd Atantat502 MULLAN RD. SUITE R
PHONE: 5`9 - et2-7 -0455
SPOKANE, WA 99206
ARCHITECT/ENGINEER:
MAILING ADDRESS:
PHONE:
Nfwt ✓1tEMonEL: ADDITION: CHANGE OF USE:
?WELL UNITS: OCCUPANT LOA?: BUILDING HGT: (4 STORIES:
BUILDING DINENSIONSt Zb A 30 (WIDTH X DEPTH) SQ. FT.: 81-0
REQUIRE? PAItRINdt 4 HANDICAP: SEWER (Y/N): HYDRANT:
Building
Planning
Engineers
.'Health
Utilities
Other
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THIS CERTIFIES
DEPARTMENT OF LABOR AND INDUSTRIES
THAT THE PERSON NAMED HEREON IS REGISTERED AS PROVIDED BY LAW AS A
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